Geriatric zootherapy: fighting elderly isolation one dog at a time

Interview with Caroline Kilsdonk, geriatry zootherapist
By Laure-Anne Visele: Interview date Aug 2014. Release date Sep 2014.

ABOUT THE AUTHOR

I am a dog trainer and canine behaviour therapist. I graduated in Zoology, certified in dog training, then got my postgrad specialization in applied animal behaviour. When I am not training dogs for OhMyDog! (dog training school in The Hague) or helping rehabilitate them, I read and write about dog behaviour.

ABOUT THE INTERVIEW PROJECT

This portrait is part of a series of talks with dog professionals around the world. I’ve interviewed behaviour-curious vets, certified dog walkers, assistance dog trainers, and university lecturers. I have these chats to get you a fly-on-the-wall view of what goes on in the world of pet professionals and their various specializations.

ABOUT CAROLINE

Caroline has a lot of hats on: she is a trained vet, mother of four, bioethics Masters student and zootherapist. Caroline lives in French Canada with her family and two dogs.

Our paths met through Human Side of Dog Training, an on-line peer-coaching group where trainers help each other navigate delicate client-trainer interactions. When I discovered she shared my addiction to learning, behaviour and philosophy, I grew even more intrigued. And then I found out what she does: zootherapy. I HAD to have a chat.

Read on as Caroline shares the special moments. If it doesn’t bring tears to your eyes, let me promise you this: you’ll never forget to call Grandma again.

MEET THE FAMILY

LV: So who’s living at the Kilsdonks’ at the moment?

CK: There’s myself and my 24-year old son and his wife who are living with us temporarily. My other son is also visiting (he studies in the Netherlands). And then there’s my two daughters (20 and 16 years old).

LV: How about the furries?

CK: There’s our two giant poodles: Leeloo (four years old) & Laïla (three years old). They’re sisters. I also regularly foster another poodle (Marylin). Then she tags along to the zootherapy visits.

HOW CAROLINE GOT THERE

LV: You trained as a vet and now you’re a zootherapist. Can you talk me through?

CK: I graduated in veterinary medicine in 1992, then worked in clinics. I also taught veterinary technicians at a College for a few years. That’s the period I had my kids and my husband was finishing off his studies so we were really busy.

LV: How did you train to work in zootherapy? What sort of knowledge did you pick up before you started?

CK: I graduated in (human) gerontology [medical and psychological aspects of aging] and followed in zootherapy certifications. I also attended hundreds of hours of conferences, congresses and seminars on animal behaviour. So I am straddling the human and animal worlds.

LV: Did you get trained in counselling skills? You deal with people at their most emotionally vulnerable. That must be tough.

CK: We did get some counselling training, to teach us how to offer psychological support. But I am very mindful of not overstepping any boundaries when I work. I am not a psychotherapist. It’s more like informal counseling, being a good ear.

LV: So how did you get your first real-life experience in zootherapy?

CK: I organized dog-child interaction workshops at primary schools. It wasn’t therapy but it got me to see how the dogs experienced it.

When I saw how much they enjoyed it, I volunteered as zootherapist in long-term geriatric care. After a while, they offered to remunerate me. And then word of mouth did the rest and three other centers asked for my services.

LV: So what is your job title? What do you call your job when people ask?

CK: I find it tricky. The word ‘therapist’ makes it sound like I offer psychotherapy. ‘Therapy’ is central in that it promotes the well-being of the persons we see, but it’s not psychotherapy. I don’t have access to medical files of the people or anything, I am not a formal part of the therapeutic team.

LV: So where do the visits fit within the processes of the care centres?

CK: Part of it is that the dogs fit with the homely, convivial atmosphere the centres try to create. Care centres are ‘Milieux de vie’ [live-in care centres rather than medical establishments]. They do their utmost to make it feel like home for the residents – not like a hospital.

LV: Is it a protected profession?

CK: No. Anyone can call themselves a zootherapist.

And there’s no pure definition of it. So I am very careful not to exaggerate any benefits or cross any boundaries. I like this new Québec law that was passed two years ago. It states that you may not call yourself a psychotherapist unless you are a member of the relevant professional board. That has clarified things a lot.

LEARNING ADDICT

LV: Are you studying anything on the side right now? Knowing your penchants, I won’t believe you if you say no.

CK: I am studying for a Master’s in Bioethics. And then of course I am following a few courses on Coursera.

LV: I am so addicted to Coursera! My friends and family even held an intervention: I have a sponsor keeping me in line. How many are you doing right now?

CK: [Silence, then, in a hush…] Five.

LV: At the same time?! [I hushed back, after having looked over my shoulder to make sure no one was listening] I am doing three at the moment.

CK: [Starts laughing, then, speaking like a true addict] In my defense, I have just been following the lectures and not doing the assignments. I’ll keep doing that as long as I’m doing my Master’s. And whatever research I do as a result of Coursera I can always re-use for my studies.

LV: Oh it IS useful. And we’re NOT being unreasonable. [laughs] But seriously. Your background makes you a great candidate for getting board-certified as a vet behaviourist. Have you contemplated this?

CK: I wouldn’t want to specialize in one thing just yet. I want to keep a wide perspective at the moment.

A DAY IN THE LIFE…

LV: Aside from your studies, do you work in animal-assisted therapy full-time?

CK: No. With the kind of personalisation and emotional intensity I put in each person, I want to keep it part-time. I really prepare for each visit.

So I am combining it with studying for my masters [Bioethics], and doing some consults on dog behaviour [mainly giving advice on introducing a new dog to the family]. I am also giving myself the space to progressively explore and set my limits.

LV: Do you always do individual visits? Or do you also organize group events?

CK: Most of the time I visit individual persons in their rooms.

LV: Do you specialize in particularly kinds of zootherapy? For Alzheimer patients, for example.

CK: I’ve been doing this for less than two years so I can’t really consider myself specialized.

LV: So the patients and dogs have a good experience, what types of skills do you need as a zootherapist?

CK: If you’re working in geriatric zootherapy, the major skill is empathy, listening. That’s another thing I’ve been reading a lot about. Teaching empathy is paradoxical as it has to be genuine. You can’t just fake it or apply it from theory or the patient will feel it. So ideally, a natural disposition to empathy is essential. And it has to be balanced as you can fall into the other extreme and end up carrying the others’ problems on your shoulders.

And of course empathy isn’t just important towards the patient, but also towards the dog. You can read a lot from the dogs’ body language. It’s important you’re ready to start slowly and not ask too much of the dogs.

And then of course it helps me a lot to have some understanding of the major health problems for people living with the sequels of a stroke, or dementia, or Parkinson’s. When I have a strong suspicion it’s playing a role, I can adapt my way of communicating.

ZOOTHERAPY IN RESEARCH

LV: I have no doubt the visits give the patients an all-too-rare break from their loneliness. Do you know how long the beneficial effects of a visit last? Has this been researched?

CK: I did a literature survey on this for a paper I had to write. Although many studies have shown positive outcomes, long-term benefits are not yet fully demonstrated by neuroscience. But you can connect the dots between, on the one hand, research on dogs’ empathy and sensitivity to human emotions and communications, and on the other other hand, research on the humans benefits from social relationships. I am presenting a short segment on this at a social neuroscience conference in Denmark: about how pet-assisted therapy can help combat loneliness in long-term care. My invitation to the social brain conference of the Federation of European Neuroscience Societies shows scientists are interested in zootherapy and I’m really happy about that.

We do know that zootherapy lowers blood pressure, depressive thoughts and anxiety, and that it causes a release of oxytocin [a feel-good hormone], though. I have a scientific mindset so I have wondered about these things a lot. What is beyond doubt is that reducing loneliness correlates to better health outcomes: less chronic pain and less depression.

But let’s put science aside for a moment: do we really have to prove that having good company makes people feel good? I am not trying to cure cancer, so I am not sure it [zootherapy] needs that much evidence. I am one of the most skeptical persons there is when it comes to pseudo-treatments but for me social bonds defy scientific scrutiny.

LV: We can get silly with our need for evidence, that’s true. Who could deny the obvious boost they get from the visit?

CK: The people we visit report that they like it, that they feel good when we are there. For me that’s a positive outcome. They say they “love those dogs” and they “can’t wait until the dogs come back.” And for some patients it’s a really big thing. They have the dogs’ pictures in their rooms and they tell their families about it; they know what day we’re coming and some of them wait for us at the door.

LV: Oh there’s no doubt it’s a hugely positive experience for these residents. I presume not everyone would get the same out of it. You’d have to be a bit of a dog person, right?

CK: It depends so much on the relationship. It’s like the studies that ask whether it’s positive to have a pet dog: it depends on the dog, the person… For some it can be a burden and for others it’s positive. The residents I visit are the ones for whom it’s positive.

LV: So you’ve just left a patient’s room and it’s clear you’ve made their day. Do you get the feeling you might have also made their week, or even their month, easier?

CK: Anecdotally, I’d say yes, absolutely. As far as evidence is concerned some studies did show the long-term benefits of weekly zootherapy sessions: with clearly reduced feelings of loneliness, anxiety and depression. But for the more cognitively impaired people, the benefits may not last very long, but they are impressive in terms of their anxiety and panic in some situations.

LV: And then there’s the ones who remember and really enjoy it, but who can’t express it, right?

CK: Even the people who can’t talk well know how to communicate perfectly with the dogs. They create their own type of interaction, they invent their own games. And the interesting thing is: the dogs remember at the next visit, so the game builds up each time they see each other.

AND FROM THE DOG’S PERSPECTIVE

LV: I attended a zootherapy lecture by a psychotherapist and zootherapist. She visits patients with different kinds of conditions. She said each of her dog was at ease with a different kind of patient. One could handle agitated patients, and the other functioned better with the more depressed ones. Do you see these differences between your girls?

CK: My dogs definitely react differently to different patients. They are fabulous at sensing how to behave appropriately in different situations.

Different patients have different styles, and the dogs remember it from visit to visit: you can tell the instant the dogs walk into the room. Some old ladies are playful and like to get the dogs a little bit excited, so the dogs carry themselves accordingly. Whereas in palliative care, the dogs seem to get a sense that everything is more calm, so they just interact calmly and affectionately.

LV: And do you see differences between the dogs’ temperaments? Is one better suited for certain types of patients?

CK: Absolutely. Eventhough all three are close kin (and obviously the same breed), they have very different temperaments. Their individual personality gives them an advantage in specific situations. I try to schedule around that so that I can, from time to time, spend more time with certain patients when I have one or the other dog.

• Younger patients would like to play all day, for example, so we’ll stay longer with Laila. She could keep playing all day.
• Leeloo is more sensitive to people’s emotions. She is the first one to turn up at home if someone is upset too.
• Marilyn is the affection seeker. She comes close and pushes the person’s hands with her nose. People love it.

LV: That same lecturer said she had to retire a couple of dogs as they were getting burnt out. Do you have those concerns about Leelo and Laila?

CK: I am not very directive with the dogs. I let them express what they need at any one time. I haven’t trained them to always do something specific when we’re at work. I have mostly just socialized them really well.

I always know if they want to get closer to the person, and if they feel good about it. Many residents can’t bend over so I’ll often ask the dogs to climb up on a chair. But I don’t just ask one dog, I ask all the dogs. The one who feels like it the most is the one who’ll climb up. They get to decide.

I think that not being directive of the dog is good. It wouldn’t have the same value to people if I forced the dogs to do it. The same goes for me actually. The residents sense that the relationship is reciprocal, that I want to be there.

LV: It must be so refreshing for them to not to feel patronized. That someone wants to be there and interact with them and to treat them as equals.

CK: They see me half way between a friend and a care provider. I am not asking questions or giving them advice, because there’s not so much distance between us. They speak very freely with me: I am not part of the healthcare system so they can complain about things, air their frustrations. They feel they can say anything. I am just neutral.

LV: So what are the main stressors on the dogs? Are they affected by the death of a patient, for example?

CK: Honestly I don’t think so. They see an individual patient maximum one hour in their week. They might notice that we’re passing the door of a room we used to visit, but that’s about it.

What used to be a major stressor was working in larger centres. Everyone would stop us in the hallways and it’s not like me to just pass by. In the end, we’d meet with dozens of people by the time we’d reached the patient’s room. Now we stick to smaller centres – less than a hundred residents. The dogs can almost feel at home there.

[Looking behind Caroline’s back on the Skype video, I saw a tall man (one of Caroline’s sons) kneel down to allow a giant ball of curly fur to work her way up into his arms. Caroline saw me smile, turned around and said:] Yes, we are very close to our dogs in this family.

LV: Your visits are extremely focused on the here and now. Do you feel more mindful in the sessions?

CK: A nurse told me that I had a warm voice and a calming influence on the patients. That made me think: “This is so not me at all.” Normally my thoughts are popping up all the time. So maybe when I visit I have to slow down and be in the moment; I have to be mindful. Maybe it has a calming effect on me.

It is probably one of the reasons I love doing this so much. I know it’s not purely altruistic. I happen to find satisfaction in something that provides well-being for others. I think it’s a really good step when our own interest matches the common good. I know you love philosophy too.

LV: Oh yes, altruism is a central philosophical questions. And biological and psychological. It’s a fascinating concept. But the job must be emotionally taxing, no?

CK: I am conscious of that possibility, but I am not doing it full-time so it doesn’t drain me.

I wouldn’t advise anyone to approach it with the intensity I do full-time. It’s just not realistic for people who want to earn a living out of it. I also don’t want the dogs to have to be efficient. I want to keep it at this level so we all keep getting something out of it, so it’s not a duty.

LV: Can you think of a work moment that particularly touched you?

CK: That’s such a difficult question. There are too many. Just thinking of the non-verbal ones, there’s this man whom I can’t speak to because he has completely reverted to his mother tongue (Spanish). But his smile when he sees us come in… The way he communicates with me, the way he thanks me. He sends me these little kisses, he kisses the dogs.

And there’s this lady I’ve been seeing for more than a year and a half now. Her husband has my phone number to tell me when she’s close to the end.

And there’s this old man very advanced dementia. They way he looks at the dogs with this wonderful caring face… And he’s so gentle with them. When he sees me he holds my hand; he pets the dogs. Just looking at him is very emotional for me. He has this therapeutic doll and usually when I leave, I clean the patient’s hand with gel. Last week I told him “I’m going to wash your hands.” He probably didn’t hear because, as I got my hand closer to him, he held out his therapeutic doll’s hand for me to wipe. These dolls give them a sense of security. It’s like a presence, and it’s something to care for. It’s very similar when they hold the dogs. Some of them sit in a rocking chair and they want to cradle the dogs, gently rocking them. Rocking a baby is a very comforting thing to do.

But there are too many of these touching moments – every day – to choose one.

PARTING WORDS

LV: I want to give you a soapbox, a chance to correct a common misconception. What comes to mind?

CK: People often underestimate the contribution of the human part of the team. They assume the dog is the sole therapeutic factor.

LV: And that you’re a glorified leash holder?

CK: Yes. But I see it as a triad, with myself as the intermediary between the dog and the patient. I facilitate communications between them. Sometimes the communication first flows between the patient and the dog, and then the dog is the facilitator. So zootherapy is a triad: the patient, me, the dogs.

FIND OUT MORE ABOUT CAROLINE

Caroline keeps contact details, pictures and diaries of her work on Caroline et les chiens (in French)